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PubMed1986

Urethral stricture complicating transurethral prostatic surgery.

The incidence of urethral stricture was 9 per cent among 336 patients after transurethral prostatic resection for benign hyperplasia. The strictures were mostly in the penile part of the urethra and could be treated with regular dilation, internal urethrotomy or meatal incision. Bacteriuria or indwelling catheter preoperatively did not seem to predispose to stricture formation. When there is an indication of a narrow urethra before TUR, a fine-calibre resectoscope should be used and a preliminary internal urethrotomy is advisable.

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PubMedDate not supplied

Transcatheter gelfoam embolization in intractable prostatic bleeding.

The authors describe a case in which protracted bleeding after a transurethral prostatic resection could not be controlled with repeated fulguration and resection. Hemostasis was obtained with transcatheter arterial Gelfoam embolization of both hypogastric arteries.

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PubMed1976

Paraplegia following transurethral surgery.

We have presented a case of paraplegia following spinal anaesthesia administered for a transurethral prostatic resection. Further investigation revealed a metastatic peridural compressive lesion at the level of T4. We have discussed some of the contributory factors involved, chiefly the lumbar puncture (perimedullary vascular engorgement, alterations in C.S.F. dynamics) and the possible role of intra-operative water intoxication (swelling of spinal cord cells).

Aged↗
PubMed1989

Immediate detection of irrigant absorption during transurethral prostatectomy: case report.

A transurethral prostatic resection is described in which immediate detection of a rapid massive irrigant absorption could be made by the use of ethanol-tagged irrigating fluid and repeated measurements of the ethanol concentration in the patient's expired breath. This monitoring enabled the surgeon to prevent further absorption by concluding the operation before symptoms resulted. Furosemide was given immediately to promote renal excretion of the absorbed irrigant, and the intravenous infusions were temporarily restricted to limit the intravascular fluid load. In retrospect, volumetric measurement showed that a total of 2410 ml of irrigant had been absorbed.

Absorption↗
PubMed1994

[Prolonged neuromuscular blockade. Different antagonistic effects following successive exposure to vecuronium and succinylcholine in a patient with atypical plasma cholinesterase].

An 81-year-old patient had prolonged competitive neuromuscular blockade with train-of-four ratios of 0.1 and 0.5, respectively, after two successive anaesthesia procedures (enflurane-N2O/O2; vecuronium-succinylcholine-sequence) for transurethral prostate resection. Although antagonism with neostigmine was promptly successful after the first, 65-min period of anaesthesia (1.5 mg vecuronium for precurarization, 100 mg succinylcholine for intubation, 3 mg vecuronium), repetitive and chronologically staggered administration of neostigmine after the second, 30-min period of anaesthesia (1 mg vecuronium for precurarization, 100 mg succinylcholine for intubation) had hardly any effect, so that the patient had to be ventilated mechanically for a total of 4.5 h. Laboratory analysis revealed homozygous, atypical, plasma cholinesterase (790 U/l; dibucaine number 23; genotype E1aE1a). This retrospectively confirmed a succinylcholine-induced phase II block in both instances, as had already been suspected following the second anaesthetic procedure. The degree of block transformation, and thus the available time, are decisive in explaining the diverse effects of antagonism here. It must be assumed that a complete phase II block developed after the first succinylcholine exposure owing to the longer duration of anaesthesia; the purely competitive component (train-of-four ratio 0.1) was easily antagonized by neostigmine. At the time of the attempted antagonism after the second, shorter period of anaesthesia, however, block transformation was still incomplete (train-of-four ratio 0.5). The administration of neostigmine therefore rather intensified the depolarization segment of the mixed block, so that repeated attempts at antagonism then inhibited any further block transformation.

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PubMed1996

[Measurement of expired alcohol concentrations with a new electrochemical sensor. A model investigation to determine interference with volatile anesthetics and clinical application].

UNLABELLED: Absorption of irrigating fluid in transurethral prostatic resection (TURP) and percutaneous nephrolitholapaxy (PNL) into veins or delayed absorption due to fluid extravasation may result in a TURP syndrome. The measurement of end-tidal breath alcohol concentration (et AC) as a monitor of absorption of irrigating fluid labelled with 2% ethanol is limited by the disturbance of infrared sensors by volatile anaesthetics and nitrous oxide (N2O) (Fig. 2). An electrochemical sensor is acceptable for this method. The aim of the present study was the evaluation of breath alcohol measurements using an electrochemical sensor device (Alcomed 3010, Envitec). The stability of the sensor in the presence of volatile anaesthetics was examined using a lung model. In a clinical investigation, the device was then applied to spontaneously breathing or mechanically ventilated patients inhaling volatile anaesthetics during endoscopic urological surgery. METHOD: A two-chamber lung model filled with water for performing noninvasive measurements at the mouth of a patient has already been introduced by Brunner et al. (Fig. 1). With the addition of different amounts of ethanol to the temperature-controlled water, a constant ethanol concentration is achievable in the air above the water that is dependent on adjustments of the ventilator. Increasing concentrations of volatile anaesthetics (isoflurane, enflurane, halothane, and sevoflurane) were added to the fresh gas flow (2 l O2/3 l N2O) and etACs were measured using the manually triggered self-absorbent electrochemical sensor. First, regression equations were established between breath alcohol concentrations and increased volatile anaesthetic concentrations. Regression equations were then established between end-tidal anaesthetic gas concentrations and vaporizer adjustments in order to rule out an influence of ethanol on the anaesthetic gas monitor Ultima V (Datex). In the clinical investigation, 53 intubated and ventilated patients (33 undergoing PNL, 20 undergoing TURP) and 48 patients breathing spontaneously (32 with inhalation anaesthesia, 16 with spinal anaesthesia) were investigated. The etAC was measured with the Alcomed 3010 and compared with gas-chromatographically registered blood alcohol concentrations (BAC). The study had previously been approved by the Ethical Committee of the Medical University of Luebeck. Patients with liver disease and a history of toxic abuse were excluded. Only one value per patient (maximum BAC) was included in the statistics in order to avoid a cluster effect. RESULTS: The lung model experiments demonstrated that the measurement of etAC with an electrochemical sensor is free of interference by volatile anaesthetics (Table 1). The slope of the regression between the measured alcohol concentration and increased concentrations of anaesthetics did not differ significantly from baseline values. The measurement of end-tidal anaesthetic concentrations was not significantly different from vaporizer adjustments in the presence of increased alcohol concentrations (Table 2). During the clinical investigation, a regression between etAC and BAC was determined for both groups. For the group of patients breathing spontaneously, the correlation coefficient was 0.961 and the regression equation revealed etAC = 0.5677*BAC-0.1303 (Fig. 5). However, in the group of ventilated patients a biphasic course was shown that was dependent on BAC (Fig. 6). At BAC < 0.4%, a similar correlation (r = 0.856) to the spontaneously breathing group could be seen (regression equation: etAC = 0.617*BAC-0.020). Above 0.4% BAC there was no acceptable correlation (r = 0.444, regression equation: etAC = 0.202*BAC+0.104). CONCLUSIONS: The tested electrochemical sensor does not interfere with volatile anaesthetics and N2O as demonstrated by a lung model. There is a good correlation between etAC and BAC measurements in patients breathing spontaneously with special regard to the slope of the regression (s = 0.57).

Anesthetics↗
PubMed1975

Evolution of urinary flow rate with prostatectomy.

Urinary flow rate was studied before and after transurethral prostatectomy in 53 patients. An average of 43.8 percent improvement in maximum flow rate after transurethral prostatectomy was observed in this series. Improvement of maximum flow rate occurred in 71 per cent of patients. Half of the cases in which flow rate did not improve were chronic prostatitis. Uroflowmetry cannot be utilized as a quality index of a transurethral prostatic resection as long as the degree of detrusor deterioration is not assessed. There is a relationship between the degree of preoperative symptoms and the degree of postoperative urinary flow improvement. The degree of preoperative symptoms and urinary flow deviation are not related which suggests that uroflowmetry adds to the assessment of symptoms in the determination of the degree of obstruction. Patients presenting difficulty of urination have a greater chance to demonstrate urinary flow improvement after surgery than patients complaining of urinary frequency.

Animals↗
PubMed1975

Periprostatic abscess. Unusual complication of transurethral prostatectomy.

Many large series analyzing the results and complications of transurethral prostatectomy have failed to mention the occurrence of periprostatic abscess. A case is described which followed perforation of the posterior capsule at the time of transurethral prostatic resection. This complication was successfully managed by transperineal needle aspiration and high-dosage antibiotic therapy.

Abscess↗
PubMed1977

Cytochrome staining of leukocytes in urine sediment. Assessment of inflammatory state.

Urinary sediments with significant pyuria were supravitally stained to assess the inflammatory state. Clinic patients showed a significant correlation between acute urinary infection, inflammation, and the predominance of live polymorphonuclear leukocytes. Post-transurethral prostatic resection patients demonstrated to show a predominance of live polymorphonuclear leukocytes, which may be clinically usefull in a more careful selection before relying fully on bacteriologic cultures.

Cystitis↗
PubMed1982

Prospective controlled assessment of fine-needle prostatic aspiration.

In this study, the cytologic diagnosis obtained by transrectal fine needle prostatic aspiration was compared to the histologic diagnosis obtained by prostatic needle biopsy or transurethral prostatic resection. Confirmation of all diagnoses occurred 91 per cent of the time: 96 per cent with benign prostatic hyperplasia, 77 per cent with carcinoma, and 100 per cent with prostatitis. Inadequate sampling for cytologic diagnosis occurred at the initiation of this study. False positive cancer diagnosis did not occur. False negative cancer diagnosis prompted appropriate follow-up. Fine-needle prostatic aspiration is a painless, simple to learn, minimally invasive, easily repeated, outpatient procedure for determining prostate pathology. The procedure should be part of each urologist's diagnostic capability.

Adenocarcinoma↗
PubMed1985

Acid phosphatase levels of irrigant solution during transurethral prostatectomy.

The acid phosphatase level of irrigant solution used during transurethral prostate resections was measured in 20 patients. The mean acid phosphatase of the irrigant solution was 45.3 IU/L (S.D. 50.7). The degree of elevation of irrigant acid phosphatase was related to the weight of tissue resected, the duration of the resection, and the total volume of irrigant used. A transient elevation of serum acid phosphatase occurred postoperatively which was associated with the level of urinary acid phosphatase elevation and the amount of absorbed irrigant solution based on changes in serum sodium.

Acid Phosphatase↗
PubMed1986

Effects of transurethral prostatectomy on nonelectrolyte components of serum.

The total serum protein, serum albumin, serum globulin, and serum cholesterol were measured in 220 patients having transurethral prostate resection. The measurements were made before surgery, at the termination of the operative procedure, and on the first postoperative day. The changes observed showed a decrease in each parameter and were compared with serum sodium measurements made at the same time intervals. The per cent change that occurred intraoperatively in total serum protein was -14.5 per cent, serum albumin -14.5 per cent, cholesterol -14.4 per cent, globulin -12.9 per cent, while serum sodium was -2.6 per cent. On postoperative day 1, only serum sodium and serum globulin showed a significant change from the immediate postoperative value. Since plasma sodium readily equilibrates with the interstitial fluid while plasma proteins do not, plasma dilution may be reflected more accurately in measurement of changes in plasma proteins and cholesterol than measurement of serum sodium.

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PubMed1987

The effect of TURP on prognosis in prostatic carcinoma.

Of 553 patients definitively irradiated for biopsy proven prostatic adenocarcinoma from January 1976 to March 1986, 287 patients with a minimum follow-up of 4 years were studied. One hundred sixty-two patients had transurethral prostatic resection (TURP); one hundred twenty-five patients did not. When subdivided by stage and histologic grade, those patients with poorly differentiated tumors who underwent TURP had a noticeably higher, but not statistically different, incidence of bony metastasis as compared to those who did not have TURP. Survival at 5 years also appeared to be better in patients with poorly differentiated and stage C disease without TURP. However, local tumor recurrence in poorly differentiated tumor with TURP was 42% as compared to 20% in the NO TURP group, p = .04. Moreover, when the incidence of osseous metastasis was assessed by local tumor status, 20% of the TURP patients with local tumor control developed metastases as compared to 66% of those with local failure. Similarly, within the NO TURP group, the incidence of bony metastasis was 16% for those with local control and 50% for those with local recurrence, p = .005 in both cases. Survival was likewise affected by local tumor control, regardless of whether or not TURP was performed. In patients with local tumor control, survival was 80% at 5 years with TURP and 86% without TURP (p greater than 0.1). In contrast, only 14% of patients with local recurrence and TURP were alive at 5 years which was not statistically different from the 32% survival in those with local recurrence but NO TURP. It seems, therefore, that comparing prognosis by TURP alone overlooks the inherent characteristics of the tumor and the extent of the disease.

Adenocarcinoma↗
PubMed2005

Do prostatic infarction, prostatic inflammation and prostate morphology play a role in acute urinary retention?

OBJECTIVE: To investigate whether there is a role of prostatic infarction, prostatic inflammation and prostate morphology in acute urinary retention (AUR) etiology. METHODS: Ninety-eight consecutive male patients who were admitted to our clinic with either AUR or lower urinary tract symptoms (LUTS) were involved in the study. Patient age ranged from 43 to 88 years (median age 70). Group 1 consisted of 53 (54%) patients with AUR, and Group 2 consisted of 45 (46%) patients with LUTS. In Group 1 and Group 2, 58.4% (n:31) and 62.2% (n:28) of the patients underwent transurethral prostate resection, 41.6% (n:22) and 37.8% (n:17) of the patients underwent suprapubic transvesical prostatectomy, respectively. Each patient was asked about the factors: smoking habits, taking previous general anesthesia and preexisting cardiovascular disease such as hypertention and atherosclerotic coronary vascular disease which may lead to AUR via prostatic infarct. Prostatic infarction, prostatic inflammation and prostatic morphology were examined in the patients' specimen. RESULTS: Mean age, median serum prostate-specific antigen (PSA) level, and prostatic inflammation ratio were significantly higher in Group 1. There were not significant differences between the groups regarding prostate volume, prostatic infarction ratio and a type of prostatic morphology. In the present study, except for taking previous general anesthesia and preexisting cardiovascular disease, only prostatic inflammation was found important contributory factor on AUR. AUR risk was 3.03 times higher in the patients with prostatic inflammation (95%CI 1.28-7.15) (p = 0.01). CONCLUSIONS: No significant effect of prostatic infarction was found on occurrence of AUR which was more frequent in elderly patients. Prostatic inflammation may have an important risk factor in AUR etiology. Additionally, serum PSA levels were higher in AUR group. No association was found between a type of prostatic morphology and AUR.

Adult↗
PubMed2006

Dynamic contrast enhanced magnetic resonance imaging as a biological marker to noninvasively assess the effect of finasteride on prostatic suburethral microcirculation.

PURPOSE: We assessed dynamic contrast enhanced magnetic resonance imaging as a biological marker of in vivo changes in microcirculation in the prostatic suburethral region. MATERIALS AND METHODS: A total of 12 male beagle dogs with spontaneous benign prostatic hyperplasia were randomly allocated to 1 control group and 1 finasteride (Merck and Co., Whitehouse Station, New Jersey) treated group. Two baseline dynamic contrast enhanced magnetic resonance imaging examinations and 3 followups were performed to assess prostate microcirculation. Treatment duration was 3 months. The pharmacokinetic parameters evaluated in prostatic suburethral areas were the maximum enhancement ratio in AU, time to maximum signal enhancement in minutes, amplitude in AU and the exchange rate constant in minutes(-1). RESULTS: After completion of the therapeutic regimen time to maximum signal enhancement was significantly longer in the finasteride group than in controls (p < 0.01). Amplitude and the exchange rate constant decreased 39% and 34%, respectively, in the finasteride group at the end of treatment, which significantly differed from results in the control group (p < 0.05). CONCLUSIONS: Dynamic contrast enhanced magnetic resonance imaging is capable of noninvasively assessing the prostatic microcirculation changes induced by finasteride. Pharmacokinetic parameters show considerable promise to be biomarkers for the development of benign prostatic hyperplasia drugs such as 5alpha-reductase inhibitors by the in vivo monitoring of microvascular changes. A relevant clinical application could be the pretreatment assessment of finasteride effectiveness to decrease perioperative bleeding at transurethral prostate resection and in treatment for hematuria.

Animals↗
PubMed2002

Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis.

PURPOSE: We retrospectively reviewed our experience with the artificial urinary sphincter for post-prostatectomy incontinence, comparing the outcome of those patients who did and did not receive previous radiation therapy. MATERIALS AND METHODS: A total of 86 patients with post-prostatectomy incontinence treated with implantation of artificial urinary sphincter includes 58 who did not (group 1) and 28 who did (group 2) receive prior radiation therapy during treatment of prostate carcinoma. In group 2 radiation was the primary treatment followed by salvage prostatectomy in 5 patients, adjuvant after radical retropubic prostatectomy 20 and after transurethral prostatic resection 3. Mean patient age plus or minus standard deviation was 68.3 +/- 6.6, and 69.7 +/- 6.6 years in groups 1 and 2, respectively. Activation of the sphincter was 4 weeks from the date of surgery, and deactivation at night was not adopted in either group. Patients were followed for a mean period of 31 +/- 23, and 36 +/- 21 months in groups 1 and 2, respectively. Comparison of continence, urodynamic testing, complication rate, overall satisfaction and quality of life was done between both groups. RESULTS: Reoperation was required in 13 (22.4%) patients in group 1 and 7 (25%) group 2 (p >0.05). Urethral atrophy and/or inadequate compression was seen in 8 (14%) and 4 (14%) patients, and urethral erosion was observed in 1 (2%) and 2 (7%) in groups 1 and 2, respectively (p >0.5). Infection of the device was observed in 4 (7%) patients in group 1 but none group 2 (p >0.05). Continence status was similar in both groups, with 60% and 64% of patients who wore 0 to 1 pad daily in groups 1 and 2, respectively (p >0.05). Urgency with or without urge incontinence was reported after implantation of artificial urinary sphincter in 47%, and 44% of patients in groups 1 and 2, respectively (p >0.05). On a visual analog scale (range 0 to 5, 0-not satisfied at all, 5-extremely satisfied) for satisfaction with the results of the artificial urinary sphincter 86% and 91% of patients reported 4 or greater in groups 1 and 2, respectively (p >0.05). CONCLUSIONS: The artificial urinary sphincter has a similar outcome in patients with post-prostatectomy incontinence whether or not they have received previous radiation therapy. No special precaution needs to be adopted for the men in group 2 with post-prostatectomy incontinence considering implantation of artificial urinary sphincter.

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PubMed2006

The prostate cancer prevention trial: design, biases and interpretation of study results.

PURPOSE: We describe the complexities of the study design of the PCPT and how they influenced the end point chosen, trial implementation, analysis and interpretation of the results. MATERIALS AND METHODS: Data from the PCPT are provided to evaluate and quantify the potential biases of this trial design. RESULTS: Six potential sources of bias, including prostate specific antigen, digital rectal examination, prostate biopsy technique, study medication nonadherence and contamination, and transurethral prostate resection are presented. These biases resulted in the need for the end of study biopsy to evaluate the trial objectives. CONCLUSIONS: There were a large number of known and potential biases that worked for and against finasteride. Because of the trial design and inherent biases, it is imperative that interim biopsy results should be interpreted with caution. While the period prevalence end point that relied on an end of study biopsy was perhaps not the most clinically relevant, it was the only way to remove as much bias as possible and meet the study objective of determining if finasteride could decrease the risk of prostate cancer. The success of the PCPT depended on constant scrutiny by the Data and Safety Monitoring Committee to monitor these biases. The design and biopsy assumptions outlined at the inception of the trial were met, including adherence and contamination rates, the for-cause biopsy rate and the final percent of men with study end points.

Bias↗
PubMed2006

Suprapubic prostatectomy with a novel catheter.

PURPOSE: We evaluated the postoperative morbidity and technical complications of a new handmade catheter used for suprapubic prostatectomy. MATERIALS AND METHODS: A total of 146 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from January 2003 to August 2004. Of the patients 96 were treated with a novel technique without a urethral catheter but with a special handmade cystostomy catheter, while the other 50 underwent the traditional procedure using cystostomy and a urethral catheter. The same surgical team operated on the 2 groups. Clot retention episodes, hemoglobin decreases, irritative symptoms, voiding status after cystostomy removal and incontinence were evaluated postoperatively. Three months later we followed the patients with symptom score, maximum flow rate and cystoscopic examination. RESULTS: Preoperatively mean International Prostate Symptom Score was 31.6 in each group. Postoperatively none of the patients with the novel catheter complained of significant irritative urinary symptoms, clot retention and true or stress urinary incontinence. Of the cohorts 94% were satisfied with voiding but 86% of controls were satisfied. There was no report of urinary tract infection or epididymo-orchitis in the cohorts, while we found epididymo-orchitis in 4 controls (8%). Three months after the operation the mean International Prostate Symptom Score was 4.4 (range 1 to 7) and the mean maximum flow rate was 22.6 ml per second (range 14 to 25) in patients with the novel catheter, and 4.2 (range 1 to 7) and 22.5 ml per second (range 15 to 25), respectively, in those with the traditional catheter. At followup there was no bladder neck contracture but 4 patients (4.1%) showed some degree of membranous urethral stricture. We also noted 7 controls (14%) with urethral stricture. CONCLUSIONS: Transurethral prostate resection has been introduced as the surgical treatment of choice in patients with benign prostatic hyperplasia. However, open adenomectomy still has a place. Urethral catheter-free suprapubic prostatectomy can be safely applied with a low postoperative risk of infection, incontinence and stricture formation.

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